Effect of Teriparatide on Fracture Healing in Intertrochanteric Fractures Treated with Proximal Femoral Nailing: A Prospective Comparative Study

Abstract

Introduction: Intertrochanteric fractures are common in the elderly and are associated with significant morbidity and delayed functional recovery. Proximal femoral nailing (PFN) is a standard method of fixation; however, fracture healing may be compromised in osteoporotic bone. Teriparatide, an anabolic agent, has been proposed to enhance fracture healing.

Aims & Objectives: To evaluate the effect of adjunctive teriparatide therapy on radiological union and functional outcomes in intertrochanteric fractures treated with PFN.

Materials & Methods: A prospective randomized comparative study was conducted on 30 patients with intertrochanteric fractures at a tertiary care hospital over a 24-month period. Patients were allocated into two groups: Group A (PFN with teriparatide, n=15) and Group B (PFN alone, n=15). Group A received subcutaneous teriparatide (20 µg/day) starting on postoperative day 7 for 24 weeks. Functional outcomes were assessed using the Visual Analogue Scale (VAS), Lower Extremity Functional Scale (LEFS), and Harris Hip Score (HHS). Radiological assessment included cortical bridging, tip-apex distance (TAD), femoral offset, and neck-shaft angle (NSA).

Results: Group A demonstrated significantly earlier fracture union (mean 11.2 weeks) compared to Group B (13.4 weeks). Patients receiving teriparatide showed better pain relief and functional scores during early follow-up (1–3 months, P < 0.05). However, functional outcomes and radiological parameters (TAD, NSA, and femoral offset) were comparable between groups at 6 months (P > 0.05). Complication rates were similar in both groups.

Conclusion: Adjunctive teriparatide therapy accelerates biological fracture healing and improves early functional recovery in osteoporotic intertrochanteric fractures treated with PFN, without affecting final structural outcomes or increasing complications.

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